Can complications in febrile neutropenia be predicted? Report from a developing country
- 463 Downloads
Febrile neutropenia (FN) is an important cause of morbidity and mortality in children with acute lymphoblastic leukemia (ALL). We aimed to look at complications in febrile neutropenia and to derive a risk model for developing complications from the variables predicting complications.
Children on treatment for ALL, presenting with FN, were prospectively enrolled over a period of 1 year. Their clinical presentation, course during hospital stay, and outcomes were recorded. Complications recorded included septic shock, pneumonia requiring invasive or non-invasive ventilation, renal failure, neutropenic enterocolitis, encephalopathy, congestive heart failure, and bleeding manifestations.
There were 320 episodes of FN among 176 patients. Complications occurred during 73 (22.8%) episodes. Time since last chemotherapy ≤7 days [OR 2.2 (1–4.5)], clinical focus of infection [OR 2.7 (1.3–5.5)], undernutrition [OR 2.5 (1.1–5.5)], absolute neutrophil count (ANC) ≤ 100/μL [OR 2.8 (1.3–5.9)], and C-reactive protein (CRP) > 60 mg/L at admission [OR 13.3 (5.2–33.8)] were independent predictors of complications. A risk model (total score = 13) was developed based on these predictors. Children with score of ≥7 had 17.2 (7.7–38.6) odds of developing complications as compared to those with score <7. Score of <7 predicted children at lower risk of complications [sensitivity 88% (78.2–93.8%), specificity 72.5% (65.7–78.4%), PPV 53.6% (44.3–62.6%), NPV 94.4% (89.3–97.1%)].
Complications during febrile neutropenia are high in a developing country setup. A risk score model based on identified risk factors can possibly help in recognizing low-risk febrile neutropenic children at admission.
KeywordsChildren Febrile neutropenia India Morbidity Prediction
Compliance with ethical standards
An informed consent was obtained from the parents. The study was approved by the research ethics board of the hospital.
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.Santolaya ME, Alvarez AM, Aviles CL, Becker A, Mosso C, O'Ryan M, Paya E, Salgado C, Silva P, Topelberg S, Tordecilla J, Varas M, Villarroel M, Viviani T, Zubieta M (2007) Admission clinical and laboratory factors associated with death in children with cancer during a febrile neutropenic episode. Pediatr Infect Dis J 26:794–798CrossRefGoogle Scholar
- 7.Bothra M, Seth R, Kapil A, Dwivedi SN, Bhatnagar S, Xess I (2013) Evaluation of predictors of adverse outcome in febrile neutropenic episodes in pediatric oncology patients. Indian J Pediatr 80:297–302Google Scholar
- 10.Santolaya ME, Alvarez AM, Aviles CL, Becker A, Cofre J, Enriquez N, O'Ryan M, Paya E, Salgado C, Silva P, Tordecilla J, Varas M, Villarroel M, Viviani T, Zubieta M (2002) Prospective evaluation of a model of prediction of invasive bacterial infection risk among children with cancer, fever, and neutropenia. Clin Infect Dis 35:678–683CrossRefGoogle Scholar
- 11.Trehan A, Bansal D, Varma N, Vora A (2017) Improving outcome of acute lymphoblastic leukemia with a simplified protocol: report from a tertiary care center in North India. Pediatr Blood Cancer 64. doi: 10.1002/pbc.26281
- 12.Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston KV, Young JA, Wingard JR Infectious Diseases Society of America (2011) Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 52:e56–e93Google Scholar
- 13.De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, Pappas PG, Maertens J, Lortholary O, Kauffman CA, Denning DW, Patterson TF, Maschmeyer G, Bille J, Dismukes WE, Herbrecht R, Hope WW, Kibbler CC, Kullberg BJ, Marr KA, Munoz P, Odds FC, Perfect JR, Restrepo A, Ruhnke M, Segal BH, Sobel JD, Sorrell TC, Viscoli C, Wingard JR, Zaoutis T, Bennett JE (2008) Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 46:1813–1821CrossRefGoogle Scholar
- 19.Santolaya ME, Alvarez AM, Becker A, Cofre J, Enriquez N, O'Ryan M, Paya E, Pilorget J, Salgado C, Tordecilla J, Varas M, Villarroel M, Viviani T, Zubieta M (2001) Prospective, multicenter evaluation of risk factors associated with invasive bacterial infection in children with cancer, neutropenia, and fever. J Clin Oncol 19:3415–3421CrossRefGoogle Scholar
- 26.International Institute for Population Sciences (IIPS) and Macro International. 2015-2016 National Family Health Survey (NFHS-4) IVI, IIPS MGoogle Scholar